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ASHRM CPHRM Prüfungsplan:

ThemaEinzelheiten
Thema 1
  • Healthcare Operations: This domain involves managing operational risk activities such as conducting risk assessments, developing policies, coordinating risk programs, supervising staff, and supporting patient safety initiatives.
Thema 2
  • Claims and Litigation: This domain focuses on handling potential claims and legal cases, including claim reporting, litigation support, legal documentation management, and analyzing claims data to understand risk exposure.
Thema 3
  • Risk Financing: This domain covers managing financial risks through insurance programs, claims coordination, loss analysis, and developing strategies to reduce financial exposure.
Thema 4
  • Clinical
  • Patient Safety: This domain focuses on improving patient safety by promoting a safety culture, managing incident reporting, educating staff and patients, addressing ethical concerns, and implementing corrective actions to reduce risks and prevent harm.
Thema 5
  • Legal and Regulatory: This domain focuses on ensuring compliance with healthcare laws and regulations, protecting patient information, managing reporting requirements, and supporting accreditation and regulatory responses.

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ASHRM Certified Professional in Health Care Risk Management (CPHRM) CPHRM Prüfungsfragen mit Lösungen (Q36-Q41):

36. Frage
If a practitioner requests a telemedicine consult with another practitioner in another state, the consultant:

Antwort: B

Begründung:
Telemedicine licensure is largely state-based in the U.S., and many states require the consulting clinician to be licensed in the state where the patient is located (with exceptions such as specific compacts, special telehealth registrations, or emergency provisions). Risk management objectives include verifying licensure
/credentialing before services, ensuring privileging-by-proxy processes where applicable, confirming malpractice coverage for telehealth and cross-state practice, and ensuring informed consent/privacy safeguards. Failure to comply can trigger regulatory penalties, payer issues, and liability exposure if care is delivered without proper authorization.


37. Frage
The due diligence process in acquisitions is undertaken to:

Antwort: A

Begründung:
Due diligence is a structured risk-identification and validation process used in mergers/acquisitions to understand clinical, legal, regulatory, operational, and financial exposures before closing. Objectives include discovering hidden liabilities (claims history, compliance gaps, credentialing issues, cybersecurity risks), validating revenue assumptions, assessing quality and safety maturity, and estimating integration costs. This informs valuation (including potential price adjustments), deal terms (representations/warranties, indemnities), and post-close priorities to improve performance and reduce adverse surprises. Risk management objectives include ensuring continuity of safe care during transition, aligning policies and governance, and preventing inherited regulatory violations or claims tail exposures.


38. Frage
Which of the following isnotone of the patient rights enumerated in the Patient Self-Determination Act (PSDA)?

Antwort: C

Begründung:
The PSDA focuses onpatient autonomy and informed decision-making, especially aroundadvance directives. It requires certain healthcare organizations to inform patients of their rights under state law to make decisions about medical care, ask whether the patient has an advance directive, document it, and avoid discrimination based on whether an advance directive exists. The Act doesnotcreate a right for patients to select any medication they want irrespective of clinical appropriateness, prescribing laws, formularies, allergies, contraindications, or standards of care. Risk management objectives here include: ensuring compliant admission workflows (education + documentation), reducing disputes through early clarification of preferences, and preventing ethical/legal breakdowns during incapacity. Operationally, PSDA compliance improves care planning, reduces unwanted treatment, and lowers complaint/litigation risk by showing the organization respected patient rights and followed required processes.


39. Frage
An interrogatory requests insurance policy information. A risk manager should

Antwort: A

Begründung:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, insurance policy information is generally discoverable in litigation. Most jurisdictions require disclosure of applicable liability coverage, including policy limits, pursuant to civil procedure rules governing discovery. Therefore, when an interrogatory properly requests insurance policy information, the organization should provide the specifically requested information in coordination with defense counsel.
Providing more information than requested, such as automatically including excess limits if not asked, may exceed the scope of the interrogatory and should be guided by legal counsel. A certificate of insurance is not a substitute for responding to formal discovery requests, as it may not contain all required details regarding coverage, limits, and applicable policy periods.
Objecting to the interrogatory without valid legal grounds is generally inappropriate, as insurance coverage information is typically relevant to potential satisfaction of judgment.
Claims and litigation objectives emphasize cooperation with counsel, compliance with discovery rules, and accurate disclosure of coverage information. Therefore, the appropriate response is to provide the specifically requested insurance policy information in accordance with legal guidance.


40. Frage
Which of the following should a risk manager consider when evaluating the effectiveness of a claims management program?
* indemnity-to-expense ratios
* total number of cases reported
* percentage of cases resolved within reserves
* percentage of cases identified prior to claim

Antwort: A

Begründung:
According to Health Care Risk Management principles outlined by ASHRM and the American Hospital Association Certification Center, evaluation of a claims management program focuses on efficiency, financial accuracy, and proactive identification of risk exposures.
Indemnity-to-expense ratios are important performance indicators that measure the proportion of funds spent on compensation versus defense costs. A balanced ratio reflects efficient claim handling and appropriate litigation management. The percentage of cases resolved within reserves evaluates the accuracy of initial reserve setting and ongoing claims assessment, demonstrating financial forecasting effectiveness.
Additionally, the percentage of cases identified prior to formal claim filing reflects proactive risk identification and early intervention practices, which may reduce litigation costs and improve resolution outcomes.
In contrast, the total number of cases reported alone does not measure program effectiveness, as volume may be influenced by patient population, service lines, or reporting culture rather than management quality.
Claims and litigation objectives emphasize accurate reserving, early case identification, and cost-effective resolution strategies. Therefore, indemnity-to-expense ratios, resolution within reserves, and early case identification are appropriate metrics for evaluating the effectiveness of a claims management program.


41. Frage
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